Provider Demographics
NPI:1063472108
Name:ABDO, RICHARD VICTOR (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:VICTOR
Last Name:ABDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1011 JEFFORDS ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-4070
Mailing Address - Country:US
Mailing Address - Phone:727-446-5993
Mailing Address - Fax:727-446-4477
Practice Address - Street 1:1011 JEFFORDS ST
Practice Address - Street 2:SUITE C
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-4070
Practice Address - Country:US
Practice Address - Phone:727-446-5993
Practice Address - Fax:727-446-4477
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2019-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0066584207X00000X, 207XS0114X, 207XX0005X, 207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL375645900Medicaid
FL591306865OtherTAX ID NUMBER
FL591306865OtherTAX ID NUMBER
FL375645900Medicaid